Comparing Health Techniques For Fractures

By Jane Farrell

A modern method of healing femur fractures is just as effective as a more established alternative, according to researchers.

The investigators, a team of orthopedic surgeons from the Perelman School of Medicine at the University of Pennsylvania, found that there’s no difference in the methods for treating distal femur fractures.  According to a news release from the university the team found that when done correctly, there are no significant differences between the two approaches – “locked plating” and “non-locked plating” – in terms of healing rates, need for corrective surgery, or hardware failure.

The findings were presented at the American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas.

In its study, the team examined medical records of 95 patients who underwent surgery to repair distal femoral fractures. These fractures, while relatively uncommon, may become more frequent as the population ages.

According to the university’s news release, for 80 percent of the patients studied, the fracture healed within 3.5 months of surgery, while 20 percent needed corrective surgery. The researchers found that patients whose surgeons used locked plating – which historically required a second revision surgery roughly 40 percent of the time – had no more setbacks than patients whose providers used non-locked plating.

The two methods differ in their use of locking and non-locking screws, respectively, to attach metal plates to fractured bone in order to provide stability and promote healing.  Locked plating virtually eliminates the possibility of the plate moving, but it has also been associated with pronounced stiffness and rigidity around the healing bone; that can prevent the bone from healing.

“Plates used in distal femur surgery come in various sizes, and have as many as 16 to 20 apertures, or screw holes,” explained the study’s senior author Samir Mehta, MD, chief of the division of Orthopaedic Trauma at the University of Pennsylvania. “In the early days of locked plating, some surgeons used screws in every one of these apertures, which we think lead to stiffness, rigidity and pain for patients. Today, surgeons are more judicious, using far fewer screws and picking and choosing which holes to insert the screws in based on factors in the case at hand. This improved decision-making on the part of surgeons is what we believe has resulted in the significant decrease in techincal problems associated with locked plating.”

“As surgeons become more adept at application of both established and developing implant technologies, outcomes will continue to improve,” said lead investigator Ryan M. Taylor, MD, a fifth-year resident in the department of Orthopaedic Surgery at the Perelman School of Medicine at the University of Pennsylvania. “However, we must remain cognizant of patient specific variables such as age, weight, and pre-existing comorbidities, which can affect overall care strategies and management.”